HomeMy WebLinkAboutMortgage_Potts (8)^' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
:.=-
= FOR DEDUCTION FROM ASSESSED VALUATION
- • State Farm 43709 (R11 / 6-09)
�'' ,�,� 1 PresaiCeE by DepartrtreM of Loral Govemment Firence
File ark
�sTRUCnoNS: 1,
To 6e filed in person a by mail with Ihe CountyAudifor or Counry Recorder o( the wunry where the property is located. 1Y1i
Fifmg Dates: 1J Real Property: Must file durirn� fhe yearlor which the detluclion is sought.
2) Mobde / ManufaUU�ed Homes rrot assessed as Real Property Must 61e dunng the hvelve (72) monfhsC �
6e(ore March 31 of each year the deduction is sought.
See reverse side Iaadditional insVUClions aiM qualifications. GIBSON
AooGre wne� u mn7raU buYer- see msf+irL'oPS m reverse side) ,
-�
Counry Audiwr
�punry Remrder
� '1 ���e,desaiF O��- 7 ��" �� J. ✓ 6 %-Q d- 8 Remrt1 O b/v � Pa9e / J O /
O"
� d rral VoP�Y as d Mart9a9e / Contraa ude6tetlnrss unpaid a N Morigaga / Convan udebtedness �mpaid as d Is ihe apPr�t Ne sde
n yea, r.�m� i. a�rem r� aace or acv�� �% O� D d d � � e 0
is ! her euG share of internst? ff wme0 wiN someone aher Ihan spouse. ind'�te with whrnn
ad is tliRerent Nan that W aPP��l'odicate bebw. Is the P�RY in qur.,nm: MnuaP/ AssesuA
. � Real RoPertY ❑',4,mi, ually Ass�s� . . .
Name W rtrortgag¢¢ ur �pntract seller
Addle55 of morlgagee W mntracl sellet (i
Name of assignee or other owner w hddi
Ade2ssofassgnee(nu`-�
Does aPpiitant own prope�ty in any oNer
couNy m Intlara? ❑
Yes
I
DeEuction approved In Me amount ot
20 _ 20 _
Sigratlire M Co�mb Auditor �
aM sf2e1, ciry, state, aM LP code)
ot mortgage
tiry, slate. an�ZIP code) i
20
I I We certity u�er the penalty M perjury that t�f{above afW
owner I convact buyer of the atoremer�tioned property on da
Full rrsitlent address of appficanl (numEer and sbeeR aty, state, aM ZIP
2/� /i�,Ql�rl�"o�Y/Y/'r ,D�l�✓E
Pe1mn auUpmed Oy Euty executed Power of Aitomey m by IC G7.1-12-
person (numbalandsbeet riry, state,
Y 7 �
COIINTY AUOROR
Dra�ti�er NO.. �,�1;�.
..
Card 1\'O. .....! 3 ,�,Sr
........
/ ( �� /.��.�
20_ � 20_
Counry
ry
2q _ � 2U _
infortnation is we and correct arW that the applicant is a resident of Indiana ard
ion is filed.
Date (rtmnfh, daY. Yge�
Date (monN. daY Yaa�